Public Smoking Research Articles

A Tobacco Control Framework for Regulating Public Consumption of Cannabis: Multistate Analysis and Policy Implications.

Eleven US states and Washington, DC, legalized recreational (adult use) cannabis. Seven states-Alaska, California, Colorado, Massachusetts, Nevada, Oregon, and Washington-allow cannabis sales. A public health concern is that exemptions in state or local smoke-free laws for public cannabis smoking or vaping will weaken smoke-free laws, expose the public to secondhand cannabis, and renormalize smoking.We describe the experience of the seven states and challenges faced in maintaining smoke-free laws. Using elements of a tobacco control framework, we identify best practices in cannabis regulation by comparing each state's smoke-free laws and allowances for public cannabis use. All states prohibit public cannabis use; two lack 100% smoke-free protections; one lacks vaping devices in its smoke-free law; three allow cannabis use in retailers; two allow cannabis use in social consumption lounges; and two allow cannabis use in tourism venues.States should close gaps in smoke-free laws and not expand where cannabis use is permitted to ensure public health.

The association between alcohol, marijuana, illegal drug use and current use of E-cigarette among youth and young adults in Canada: results from Canadian Tobacco, Alcohol and Drugs Survey 2017

BackgroundE-cigarettes have grown in popularity around the world since 2003. Although marketed as a smoking cessation tool, e-cigarettes can lead to tobacco cigarette smoking in youth. In Canada, among all age groups, youth and young adults have the highest prevalence of e-cigarette use. The objective of this study was to assess the factors associated with e-cigarette use among youth and young adults in Canada, and to specifically examine the association between alcohol, marijuana and illicit drug use.MethodsData from the 2017 Canadian Tobacco, Alcohol and Drugs Survey were used. The sample was restricted to those aged 15–24 years (n = 10,322), and main outcome defined as ‘E-cigarette use in the past 30-days’. Multivariable logistic regression was performed to assess the association between the main outcome and substance use variables (illicit drug, marijuana and alcohol use), tobacco exposure variables, and demographic and health-related factors.Results6.2% Canadians aged 15–24 reported using e-cigarettes in the past 30-days, while 23.9% reported having ever tried e-cigarettes. Twenty-three percent of the past 30-day users reported using e-cigarettes every day and 72.5% of the past 30-day users reported having nicotine in their last e-cigarette. Additionally, youth aged 15–17 were 4.95 times more likely to be e-cigarette users as compared to those aged 22–24 (OR: 4.95, 95% CI: 3.1–7.9). Moreover, e-cigarette use was significantly associated with marijuana use (OR:4.17, 95% CI: 2.6–6.7) and alcohol use (OR: 5.08, 95% CI: 2.9–9.0), and approached significance with illicit drug use (OR: 1.68, 95% CI: 1.0–2.9). Furthermore, being a current smoker (OR: 2.93, 95% CI: 1.8–4.7) and male (OR: 2.28, 95% CI: 1.5–3.4) was significantly associated with the outcome.ConclusionThis study is nationally representative and provides insight into e-cigarette use among youth and young adults aged 15–24 years. Given that e-cigarettes can be used as illicit drug delivery systems, more studies are needed to understand how Canadian youth and young adults are using e-cigarettes. Stricter restrictions on public e-cigarette smoking, and awareness campaigns informing youth of risks of e-cigarette smoking should be implemented.

Effect of tobacco control policies on intention to quit smoking cigarettes: A study from Beirut, Lebanon.

INTRODUCTIONIn Lebanon, the tobacco control policy, Law 174, became effective in 2011. Using the International Tobacco Control Policy Evaluation Project (ITC) conceptual model, this study aims to assess the association between exposure to control measures related to the policy and the intention to quit, which is a mediator in the pathway leading to behavioral change (quitting).METHODSThis is a secondary data analysis of 154 cigarette smokers from a cross-sectional survey that assessed compliance with Law 174 among Beirut residents aged 15–65 years. Data were collected face-to-face, three months after the implementation of indoor public places and tobacco advertisement/promotion bans. Intention to quit smoking was the main outcome. Exposure to policy control measures such as seeing smokers in restaurants, and noticing warning labels on cigarette packs were the explanatory variables. Sociodemographics, past smoking behavior, and psychosocial variables were also considered for their moderating and mediating effects, respectively. Crude and adjusted odds ratios (ORs) were generated. Sobel test was used to check for possible mediation.RESULTSIntention to quit was reported by 24% of cigarette smokers. The association between noticing warning labels and having intentions to quit was statistically significant (adjusted OR=6.27). Concerns about influencing children’s smoking behavior had a statistically significant mediation effect on the relationship. After adding the interaction term between noticing the warnings and previous quit attempts, the OR was inflated to 12.92, suggesting a possible interaction.CONCLUSIONSThis study offers preliminary insight into how Lebanese smokers are influenced by policy related control measures like health warning labels on cigarette packs. Tobacco control policy advocates should push for stronger enforcement of public smoking bans in general. Behavioral intervention should work on the mediator variables to influence smoking behavior and encourage quitting. Further prospective studies modelling quitting as outcome are needed.

Evaluating the effectiveness and cost-effectiveness of the Smoking Treatment Optimisation in Pharmacies (STOP) intervention: protocol for a cluster randomised controlled trial

BackgroundNHS community pharmacies provide effective smoking cessation services; however, there is scope for increasing throughput and improving quit rates. This trial examines whether the Smoking Treatment Optimisation in Pharmacies (STOP) intervention can improve smoker engagement to increase service throughput, retention and quitting.MethodsThis study is a pragmatic, cluster randomised controlled trial in 60 pharmacies in England and Wales. All workers in intervention pharmacies are offered STOP training while control pharmacies provide usual care. The STOP intervention, based on behavioural and organisational theories, comprises educational sessions for staff and environmental prompts in the pharmacy. Intervention fidelity is assessed by actors visiting pharmacies posing as smokers. The primary outcome is throughput, defined as the number of smokers who join the programme, set a firm quit date and undergo at least one stop smoking treatment session, and is measured using routinely collected data. Secondary outcomes include retention and quit rates at 4 weeks and continuous abstinence at 6 months verified by salivary cotinine. Cost-effectiveness is estimated using quality-adjusted life years and the probability that the intervention is effective at different levels of willingness to pay is calculated.DiscussionThe trial will generate evidence to inform the public health smoking cessation strategy in England and Wales, and may help to shape service commissioning decisions. The STOP intervention model may help inform the undertaking of a range of health behaviour change tasks in community pharmacies.Trial registrationClinicalTrials.gov, ISRCTN16351033. Retrospectively registered on 21 March 2017.

Current smoking habits in British IBD patients in the age of e-cigarettes

BackgroundSmoking has a detrimental effect on Crohn’s disease (CD) while data on ulcerative colitis (UC) are conflicting. Smoking habits have changed dramatically in the UK due to a public smoking...

Measuring the Effect of Policy on the Demand for Menthol Cigarettes: Evidence from Household-Level Purchase Data

I use detailed household-level data to investigate the potential impact of a ban on menthol cigarettes on smoking when compared to intervention policies such as taxes and public smoking restrictions. The results show that menthols are less addictive than non-menthols and that demand for menthol cigarettes is less price sensitive. Public smoking restrictions are unsuccessful in reducing menthol smoking, though they do reduce non-menthol consumption. Additionally, higher prices do not increase the likelihood of quitting for menthol smokers. These findings indicate that current policies are ineffective in curbing menthol smoking and strengthen the case for a complete ban.

Mediation Centrality in Adversarial Policy Networks

Conflict resolution often involves mediators who understand the issues central to both sides of an argument. Mediators in complex networks represent key nodes that are connected to other key nodes in opposing subgraphs. Here we introduce a new metric, mediation centrality, for identifying good mediators in adversarial policy networks, such as the connections between individuals and their reasons for and against the support of controversial topics (e.g., state‐financed abortion). Using a process‐based account of reason mediation we construct bipartite adversarial policy networks and show how mediation defined over subgraph projections constrained to reasons representing opposing sides can be used to produce a measure of mediation centrality that is superior to centrality computed on the full network. We then empirically illustrate and test mediation centrality in a “policy fluency task,” where participants generated reasons for or against eight controversial policy issues (state‐subsidized abortion, bank bailouts, forced CO2 reduction, cannabis legalization, shortened naturalization, surrogate motherhood legalization, public smoking ban, and euthanasia legalization). We discuss how mediation centrality can be extended to adversarial policy networks with more than two positions and to other centrality measures.

Menthol Cigarettes, Tobacco Dependence, and Smoking Persistence: The Need to Examine Enhanced Cognitive Functioning as a Neuropsychological Mechanism.

Despite the overall decline in the prevalence of cigarette use in the United States, menthol cigarette use among smokers is rising, and evidence shows that it may lead to more detrimental effects on public health than regular cigarette use. One of the mechanisms by which nicotine sustains tobacco use and dependence is due to its cognitive enhancing properties, and basic science literature suggests that menthol may also enhance nicotine's acute effect on cognition. The purpose of this review is to suggest that the cognitive enhancing effects of menthol may be a potentially important neuropsychological mechanism that has yet to be examined. In this narrative review, we provide an overview of basic science studies examining neurobiological and cognitive effects of menthol and menthol cigarette smoking. We also review studies examining menthol essential oils among humans that indicate menthol alone has acute cognitive enhancing properties. Finally, we present factors influencing the rising prevalence of menthol cigarette use among smokers and the importance of this gap in the literature to improve public health and smoking cessation treatment. Despite the compelling evidence for menthol's acute cognitive enhancing and reinforcing effects, this mechanism for sustaining tobacco dependence and cigarette use has yet to be examined and validated among humans. On the basis of the basic science evidence for menthol's neurobiological effects on nicotinic receptors and neurotransmitters, perhaps clarifying menthol's effect on cognitive performance can help to elucidate the complicated literature examining menthol and tobacco dependence. Menthol cigarette use has continued to be a topic of debate among researchers and policy makers, because of its implications for understanding menthol's contribution to nicotine dependence and smoking persistence, as well as its continued use as a prevalent flavoring in tobacco and nicotine products in the United States and internationally. As international tobacco regulation policies have begun to target menthol cigarettes, research studies need to examine how flavoring additives, specifically menthol, may acutely influence neurobiological and cognitive functioning as a potential mechanism of sustained smoking behavior to develop more effective treatments.

Grass roots approach to control levels of carcinogenic nitrosamines, NNN and NNK in smokeless tobacco products

Due to the extensive ban on public smoking, tobacco companies focused their business on new smokeless tobacco (SLT) products promoting them as a harm reduction strategy and a safer alternative to cigarettes. Two nitrosamines, N′-nitrosonornicotine (NNN) and nicotine-derived nitrosamine ketone (NNK), present in SLT, listed as group 1 human carcinogens by the International Agency for Research on Cancer, are found to be the prime agents for most of cancers in SLT users. This review illustrates the mechanism of cancer induction by NNN and NNK in humans along with factors influencing the formation of NNN and NNK at various stages of tobacco manufacturing. It reveals the high levels and wide variations of NNN and NNK found among the diverse variety of SLT products sold worldwide. According to a recent report by FDA- Centre for Tobacco Products, reducing levels of nitrosamines in SLT products could greatly enhance the quality of life by reducing mortality, morbidity and medical expenditures due to cancer. For the first time, grass root approaches to minimize the levels of NNN and NNK in tobacco, from plant growth to the finished products, have been systematically compiled as they have the potential to contribute to reducing tobacco related disease burden.

Testing for forward-looking behaviour: evidence from the enactment of smoking restrictions

ABSTRACTThis paper develops a new test for forward-looking behaviour based on the establishment of public smoking restrictions. Given that the announcement of these restrictions effectively increases the future cost of smoking, we should expect forward-looking smokers to curb their consumption before the restriction is effective due to complementarity between present and future consumption. I perform the estimation using detailed, high-frequency household-level purchase data. The results provide evidence against the forward-looking behaviour of smokers. Households do not reduce their cigarette purchases before announced public smoking restrictions are established; they only do so once the restriction is in effect.

The impact of a public smoking ban on smoking socioeconomic inequalities in a Swiss urban population

The impact of a public smoking ban on smoking socioeconomic inequalities in a Swiss urban population

The impact of a public smoking ban on smoking socioeconomic inequalities in a Swiss urban population

The impact of a public smoking ban on smoking socioeconomic inequalities in a Swiss urban population

Smoking and wage rates – Evidence from Japanese panel data

This paper analyzes smoking behavior and its effects on wage rate. It is widely known that smoking has negative health effects and to discourage the practice, governments frequently implement policies such as tax increases and restrictions on public smoking. To evaluate these policies, it is necessary to understand the economic benefits and costs of reducing the number of smokers. We conduct a panel data analysis while controlling for unobserved heterogeneity and show that smoking is not the main factor causing observed wage differentials between smokers and non-smokers in Japan.As for the relationship between smoking and wages, we find that male smokers receive lower hourly wages than male nonsmokers. Smoking behavior generally depends on environmental, congenital, or social factors. These factors, however, do not only affect smoking behavior but also the wages of these individuals. To isolate the effect of smoking on wages, we control for individual heterogeneity using panel data to verify the existence of such an effect.Using tax change as an instrumental variable in the fixed effects model and several robustness checks, the results show that smoking has no statistically significant effect on wage rate. This suggests that smoking does not directly affect wages; rather, unobserved individual heterogeneity (other factors influencing both smoking and wages) leads to wage differences between smokers and nonsmokers. Nevertheless, smoking can affect wages in the long run through health problems. The nine-year panel data used in this research, however, is insufficient to capture the long-term indirect health effects. Thus, future research should consider analyzing indirect health effects using panel data spread across a wider time frame.

The health effects of smoking bans: Evidence from German hospitalization data.

This paper studies the short-term impact of public smoking bans on hospitalizations in Germany. It exploits the staggered implementation of smoking bans over time and across the 16 federal states along with the universe of hospitalizations from 2000 to 2008 and daily county-level weather and pollution data. Smoking bans in bars and restaurants have been effective in preventing 1.9 hospital admissions (-2.1%) due to cardiovascular diseases per day, per 1 million population. We also find a decrease by 0.5 admissions (-6.5%) due to asthma per day, per 1 million population. The health prevention effects are more pronounced on sunny days and days with higher ambient pollution levels.

Impact of Public Smoking Bans on Social Inequalities in Children's Exposure to Tobacco Smoke at Home: An Equity-Focused Systematic Review.

A systematic review was conducted to evaluate the impact of public smoking bans on social inequalities in children's secondhand smoke (SHS) exposure at home. Five databases were electronically searched for articles on children's SHS exposure at home related to public smoking bans. In addition, the gray literature and German public health journals were considered. Search was restricted to English and German publications. Of 3037 records screened, 25 studies fulfilled the inclusion criteria by either measuring SHS exposure before and after public smoking ban introduction or by comparing exposure between regions with and without smoke-free legislation. Studies were further examined whether they additionally reported on impacts on social inequalities in SHS exposure. Information on children's SHS exposure at home in relation to smoke-free legislation were extracted by one reviewer and checked for accuracy by a second reviewer. According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Equity (PRISMA-E) guidelines for equity-focused systematic reviews, the PROGRESS-Plus framework was applied to data extraction and analysis with focus on social inequalities in SHS exposure. Results were visualized by a harvest plot. Eight studies gave results on the impact of public smoking bans on social inequalities in children's SHS exposure. Whereas only one study indicated widening of the social gap in exposure, seven studies showed no impact or a reduction of social inequalities in exposure. First evidence on short-term impact of public smoking bans does not support the assumption of intervention-generated inequalities in children's SHS exposure at home. Future studies should focus on long-term equity impacts of smoke-free legislation. There are substantial social inequalities in children's SHS exposure in many countries. Both hypotheses on the effect of smoke-free legislation on children's SHS exposure at home, the displacement hypothesis and the social diffusion hypothesis, did not take social inequalities into account. Up to now, only few studies analyzed the effects of smoke-free legislation on social inequalities in children's SHS exposure at home. Public smoking bans had overall no negative impact on social inequalities in children's SHS exposure at home. More consistent reporting of absolute and relative inequalities is needed to comprehensively assess equity impact of smoke-free legislation.

Impact of public smoking bans on children\u2019s exposure to tobacco smoke at home: a systematic review and meta-analysis

BackroundMeta-analysis of the impact of public smoking bans on children’s exposure to secondhand smoke (SHS) exposure at home.MethodsThe electronic databases of PubMed, Web of Science, PsycINFo, ASSIA, CINAHL were searched. German public health journals not captured by these databases and grey literature were considered in addition.Studies were included when they reported children’s SHS exposure at home in relation to smoke-free legislation by measuring exposure before and after the introduction of a public smoking ban. Studies had to provide results on exposure prevalences of children aged below 18 years. Language of publications was restricted to German and English.Details of the included studies (n = 15) were extracted by one author and checked for accuracy by a second author. Given the exposure prevalences before and after the introduction of a smoke-free legislation, a random-effects meta-analysis of relative risks (RR) was conducted. Results were presented in a forest plot.ResultsMeta-analysis showed that the overall effect was a decreased exposure to SHS in the children’s homes after introduction of a public smoking ban (RR = 0.72; 95% CI = 0.62–0.83). Only two of the 15 studies indicated an increased exposure. Sensitivity analyses considering the type of smoke-free legislation, children’s age group and study quality did not substantially alter the result.ConclusionThe assumption of a displacement of smoking into homes with children due to smoke-free legislation in public places could not be confirmed. Additional research is needed to analyse long-term trends.

Using a Bayesian Structural Time–Series Model to Infer the Causal Impact on Cigarette Sales of Partial and Total Bans on Public Smoking

Abstract The Bayesian structural time series model, used in conjunction with a state–space model, is a novel means of exploring the causal impact of a policy intervention. It extends the widely used difference–in–differences approach to the time series setting and enables several control series to be used to construct the counterfactual. This paper highlights the benefits of using this methodology to estimate the effectiveness of an absolute ban on smoking in public places, compared with a partial ban. In January 2006, the Spanish government enacted a tobacco control law which banned smoking in bars and restaurants, with exceptions depending on the floor space of the premises. In January 2011, further legislation in this area was adopted, removing these exceptions. The data source used for our study was the monthly legal sales of cigarettes in Spain from January 2000 to December 2014. The potential control series were the monthly tourist arrivals from the United Kingdom, the total number of visitors from France, the unemployment rate and the average price of cigarettes. Analysis of the state–space model leads us to conclude that the partial ban was not effective in reducing the tobacco sold in Spain, but that the total ban contributed significantly to reducing cigarette consumption.

Assessment of compliance of prohibition of smoking (under section-4 of cigarettes and other tobacco products act) in Raipur city (C.G.), India: a cross sectional study

Background: Use of tobacco has been proven to be one of the leading causes of preventable premature deaths and diseases across the globe. The global adult tobacco survey (GATS) India report 2009-10 estimates 34.6% of India’s adult population use tobacco in some form or other. The government of India has taken various initiatives for tobacco control by enacting comprehensive tobacco control legislation (Cigarette and Other Tobacco Products Act {COTPA}, 2003). The objective of the study was to assess the level of compliance of section 4 of COTPA in public places of Raipur.Methods: A cross sectional observational study was conducted in Raipur. The study was done around 480 public places for observing the compliance of section 4 of COTPA.Results: From the total 480 public places visited, 36.9% public places displayed “No Smoking” signage, out of 117 public places where “No Smoking” signage displayed only 11.3% were as per the COTPA specification. Only 12.3% of public places active smoking was observed during visit.Conclusions: This finding suggests a poor level of compliance of section 4 of COTPA in Raipur. Although the law has been drafted comprehensively, it is implemented only to certain extent.

Prevalence and factors associated with exposure to secondhand smoke (SHS) among young people: a cross-sectional study from the Gambia

BackgroundAnnually, 600 000 deaths are attributed to exposure of non-smokers to secondhand smoke (SHS). These include 165 000 among children, about 60% of which occur in Africa and Southeast Asia....

Impact of Smoking Ban on Passive Smoke Exposure in Pregnant Non-Smokers in the Southeastern United States.

Prenatal passive smoke exposure raises risk for negative birth outcomes. Legislation regulating public smoking has been shown to impact exposure levels, though fewer studies involving pregnant women have been conducted within the U.S. where bans are inconsistent across regions. This study examined the effect of a ban enacted in the southeastern U.S. on pregnant women’s cotinine levels. Additional analyses compared self-reported exposure to cotinine and identified characteristics associated with passive exposure. Pregnant women (N = 851) were recruited prospectively between 2005 and 2011 in North Carolina. Sociodemographic and health data were collected via surveys; maternal blood samples were assayed for cotinine. Among non-active smokers who provided self-report data regarding passive exposure (N = 503), 20% were inconsistent with corresponding cotinine. Among all non-smokers (N = 668), being unmarried, African American, and less educated were each associated with greater passive exposure. Controlling for covariates, mean cotinine was higher prior to the ban compared to after, F(1, 640) = 24.65, p < 0.001. Results suggest that banning smoking in public spaces may reduce passive smoke exposure for non-smoking pregnant women. These data are some of the first to examine the impact of legislation on passive smoke exposure in pregnant women within the U.S. using a biomarker and can inform policy in regions lacking comprehensive smoke-free legislation.